Medicaid Waiver Eligibility: Process and Program Requirements
In Alaska, there are several ways to pay for services that can be provided in your home. Medicaid is the primary payment source for many individuals. The services vary in each community depending on your needs and the availability of providers in your specific location. The Medicaid Waiver is a type of Medicaid program that has very specific services associated with each program. This section will provide information regarding the Alaska Medicaid Wavier application process and the program requirements for each program. This is reference information.
Medicaid Wavier is a program that extends the medical support and rehabilitative services of Medicaid to an individual based on specific assessed and diagnosed conditions. The program offers payment for Home and Community Based services or institutional care in a facility, such as an Assisted Living Home or Group Home.
These waiver programs offer a choice of services for people who meet a nursing facility level of care (NFLOC).
To access one of these waiver programs, a person must meet:
- Medicaid eligibility requirements for income and resource limits, as found the application process with the Division of Public Assistance (DPA), and
- Level of care requirements are assessed and determined by the State of Alaska Division of Senior and Disabilities Services Assessment Unit. The assessor conducts a functional assessment via in person interviews or by using videoconferencing technology.
As with any government process there are several steps to take to apply for the services.
Steps to obtain a Medicaid Waiver
1. Application for Medicaid using form GEN50C Application for Services
(http://dpaweb.hss.state.ak.us/e-forms/pdf/GEN-50C.pdf), Elders and applicants with disabilities are encouraged to use the paper application. The application process requires the completion of a phone interview with the staff at the Division of Public Assistance. At the time of the interview, the applicant can tell the interviewer that they are seeking the Medicaid Wavier services. If the applicant is income eligible for Medicaid, the interviewer can adjust the program type to the Medicaid Waiver. The applicant will be determined if they are eligible for both medical care services and higher level of services under the Medicaid Waiver.
1a) Application for Medicaid using form MED-4, (http://dpaweb.hss.state.ak.us/e-forms/pdf/MED-04.pdf) Medicaid Application for Adults and Children with Long Term Care Needs is a paper application. The income eligibility for only the Medicaid Waiver is higher than Medicaid thus an applicant could obtain a Medicaid Waiver but not have Medicaid covering all medical care services.
2. Contact the local Aging and Disability Resource Center (ADRC)
In SE Alaska this is Southeast Alaska Independent Living (SAIL). They can be reach at 1-800-478-7245 or on the web at https://www.sailinc.org/. Ask them for an appointment for a Person-Centered Intake (PCI). The PCI is an assessment that SAIL staff will conduct with the applicant. There is no cost related to the assessment. The assessment process takes about an hour and will offer the applicant with information about their potential eligibility for Medicaid Home and Community Based Services (HCBS), Community First Choice (CFC), and Personal Care Services (PCS). SAIL staff will counsel the applicant about their options for services.
- When potential eligibility for HCBS occurs, the SAIL staff will provide a referral to a Care Coordinator who can assist with the finalizing of an application for the Medicaid Waiver Services and the development of a Plan of Care.
- The Care Coordinator will assist the applicant in establishing a Nursing Facility Level of Care (NFLOC)Assessment through the Division of Senior and Disabilities Services. From the date that the Care Coordinator submits a completed application the State of Alaska has 30 days to schedule the NFLOC assessment with the applicant. This assessment is conducted in-person or by video-conferencing to determine the functional eligibility for the Medicaid Waiver. The assessment determine the level of care that the applicant’s medical condition meets. To be eligible for Medicaid Waiver the applicant must meet nursing home level of care. To meet NFLOC, the participant must meet the criteria by needing 1) substantial amounts of medical care or 2) extensive hands-on assistance with three or more activities of daily living (ADL) (however needing assistance with bathing and dressing is not counted). Individuals can also meet NFLOC though different combinations of medical care, ADLs, behavior and/or cognition issues.
- When potential eligibility for PCS occurs, the SAIL staff will provide the applicant with information regarding local agencies that provide PCS services.
The applicant then contacts the agency of their choice directly to establish services.
- When potential eligibility for HCBS occurs, the SAIL staff will provide a referral to a Care Coordinator who can assist with the finalizing of an application for the Medicaid Waiver Services and the development of a Plan of Care.
3. Picking a PCS agency
Many communities in Se Alaska have limited agencies to choose from for in-home services. Most offer Medicaid related services through the Consumer Directed model of care. Consumer Directed services are in-home care that is provided by a caregiver chosen by the individual receiving the care. In most cases, the individual will hire “Natural Supports” like family or friends to act as caregivers. Some agencies may have staff who are available that are not family or friends to the disabled adult or senior. Some agencies will place the disabled individual or senior on a waiting list for services while attempting to hire a community staff member.
When you call an agency, ask about the status of their staffing availability. You may need to be flexible with scheduling your care. For example, Medicaid may authorize you for 20 hours per week of care while the agency only has staffing for 10 hours per week of care. If the match with the staff is acceptable, request the care for the 10 hours per week while awaiting additional staff to be hired or more hours to become available. Working with the agency will assist in finding staff to meet your needs. Often in-home care agencies and caregivers will work with you and provide suggestions for alternative care options while developing your in-home care staffing.
When hiring a family member or friend to act on your behalf, they will be employed by an agency. This will require the family member or friend to comply with the requirements for criminal background checks and training such as CPR and First Aid. You will want to speak with the agency specifically about the requirements. The family member or friend will need to contact the agency directly for hiring. Some agencies will visit with a disabled adult or senior to help them identify and to solicit natural supports for assistance.
Community Specific Personal Care Service Agencies
Haines/Klukwan – Cornerstone Home Health, Consumer Direct
Skagway – Consumer Direct
Gustavus – Consumer Direct
Hoonah – Cornerstone Home Health, Consumer Direct
Juneau/Douglas – Cornerstone Home Health, Compass Home Care, Consumer Direct
Angoon – Consumer Direct, Cornerstone Home Health
Tenakee – Consumer Direct
Pelican – Consumer Direct
Sitka – Center for Community, Consumer Direct
Wrangell – Consumer Direct
Petersburg – Cornerstone Home Health, Consumer Direct
Ketchikan/Saxman – Community Connections, Consumer Direct
Metlakatla – Community Connections, Consumer Direct
Prince of Wales – Community Connections, Consumer Direct
Hyder – Consumer Direct
Kake – Center for Community, Consumer Direct
The Medicaid Wavier Program offers several options: